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1、临床医学论文•自发性胆囊内痿的临床分析【摘要】目的总结胆囊内痿的临床特征和诊治经验。方法回顾性分析21例自发性胆囊内痿的临床资料。结果21例均有不同程度的右上腹痛‘部分伴有发热、黄疸、恶心和呕吐等症状。胆囊十二拒肠痿9例；胆囊胆管痿6例；胆囊结肠痿4例，其中1例为胆囊横结肠痿合并腹壁痿；胆囊胃痿2例。术前常规行B超检查并结合CTW1RCPFRCP、胃肠造影等检查，术前明确诊断者11例(52.38%)。全部行胆囊切除或部分切除。11例行胃肠痿口修补术'1例行胆总管切开T管引流术和十二指肠造痿术，2例行十二指
2、肠痿口修补和毕II式胃大部切除术，5例痿口较大的胆管痿者用部分胆囊壁修补和T管引流，1例行胆管空肠Roux-en-Y吻合术，1例行胆囊癌姑息切除并行T管引流术。1例术后因呼吸衰竭而亡，1例死于胆囊癌复发转移，其余均痊愈出院。结论对萎缩性胆囊炎或长期发作的胆囊炎，应考虑胆囊内痿的可能。结合B超检查、CT、MRCP、ERCP、胃肠造影等检查'可提高术前诊断率。治疗应根据痿口的部位、大小等个体化原则进行。【关键词】胆囊内痿；胆结石；胆囊炎[Abstract]ObjectiveTosummarizetheclin
3、icalexperienceintreatmentanddiagnosisofspontaneousgallbladderinternalfistula(SIGF).MethodsClincialdataof21caseswereanalyzedretrospcctivcly.ResultsAl1ofthepatientshadtheclinicalsymptomsofdifferentdegreerightabdominalpain,andsomepatienthadtheclinicalmanifes
4、tationoffever,nausea,vomitingandjaundiceatsametime.Therewere9cholccystoduodcnalfistulaeases,6cholangiocholccysticfistula,4cysticolicfistulaincludedin1abdominalwal1fistulacase,2cholecystogastricfistula・Bultrasonographywasusedinal1patientscombinedwithCT,MRC
5、P,ERCP,gastrointestinalcontvastexaminationandothermethodsinsomepatients.Inthisgroup,12caseswerediagnosedpreoperativelytosufferfromSIGF・Al1the21patientsreceivedcholecystectomyorpartialcholecystectomy.Elevenfistulaeintheenterogastrictractwererepaireddirecti
6、y.Onepatientunderwentthecholcdochotomy,Ttubedringagcandcntcrostomy.2patientsdidduodenalfistularepairandBi11roth-IIsubtotalgastrectomy.Ttubedringageandrepairwithpartofthegallbladderwa11weredidinthehighersizeoffistulain5cholangiocholecysticfistula.Onepatien
7、tunderwenttheRoux-en-Ycholedochojejunostomyandanotherpatientdidthepal1iativecholecystectomyofgallbladdcrcancer.Only1diedofrcspiratoryfailureandanotherdiedofrecurrenceandmetastasisofgallbladdercancer.ConclusionWeshouldthinkoftheSIGFexistenceinthepatientswh
8、ohadtheatrophicorlongcholecystitis.ltmayberaisethediagnosticcorrectnessofSIGFwithBultrasonography,CT,MRCP,ERCP,gastrointestinalcontvastexaminationandothermethods.Thetreatmentdependonthelocality,sizeandotherfactorsof
